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CHANGING A DRY STERILE DRESSING DEFINITION: Sterile dry dressings are used for wounds such as surgical incisions

that have minimal drainage and no tissue loss and that heal by primary intention. PURPOSE: 1. To promote wound healing by primary intention. 2. To prevent infection. CONSIDERATIONS: 1. Instruct caregivers to provide pain medication approximately 30 minutes before the procedure if the wound care causes pain or discomfort. 2. Handle all sterile supplies from the outside of the wrapper or the edges. 3. Vascular changes associated with aging, such as atherosclerosis and atrophy of capillaries in the skin, can impair blood flow to the wound. EQUIPMENT: 1. A sterile dressing set that includes A drape or towel Cotton balls or gauze squares to clean the wound A container for the cleaning solution An antimicrobial solution Two pairs of forceps (thumb or artery) Gauze dressings and surgipads Applicators or tongue blades to apply ointments. 2. If a set is not available, gather these items from a central supply cart. - Additional supplies required for the particular dressing - Disposable gloves. - Sterile gloves - A mask - A moistureproof bag for disposal of the old dressings and the used cleaning gauzes. - Tape or tie tapes to secure the dressing. - A bath blanket , if necessary , to cover the client and prevent undue exposure. - Acetone or another solution to loosen adhesive, if necessary.

INTERVENTIONS Preparing the client 1. Acquire assistance for changing a dressing on a restless or confused adult. 2. Assist the client to a comfortable position , in which the wound can be readily exposed. Expose only the wound area, using a bath blanket to cover the client , if necessary. Make a cuff on the moistureproof bag for disposal of the soiled dressing, and place the bag within reach. It can be taped to the bedclothes or bedside table.

RATIONALE The person might move and contaminate the sterile field or the wound. Undue exposure is physically and psychologically distressing to most people.

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Making a cuff keeps the outside of the bag free from contamination by the soiled dressings and prevents subsequent contamination of the nurses hands or of sterile instrument tips when discarding dressings or sponges. Placement of the bag within reach prevents the nurse from reaching across the sterile field and the wound and potentially contaminating these. Many agencies require that a mask be worn for surgical dressings changes to prevent contamination of the wound by droplet spray from the nurses respiratory tract. To expose the wound and be systematic in the procedure.

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Don a face mask.

Removing the Soiled Dressing 5. Removable binders, if used , and place them aside. Untie tie tapes, if used. 6. If adhesive tape was used , remove it by holding down the skin and pulling the tape gently but firmly toward the wound. Use a solvent to loosen the tape, if required.

Pressing down on the skin provides countertraction against the pulling motion. Tape is pulled toward the incision to prevent strain on the sutures or wound. Moistening the tape with acetone or similar solvent lessens the discomfort of removal, particularly from hairy surfaces. The outer surgipad is considered contaminated by the clients clothing and linen. The appearance and odor of the drainage may be upsetting to the client.

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Don gloves and remove the outer abdominal dressing or surgipad by hand if the dressing is dry, or using disposable glove if the dressing is moist. Lift the dressing so that the underside is away from the clients face. Place the soiled dressing in the waterproof bag without touching the outside of the bag. Remove glove(s) , dispose of them in the waterproof bag, and wash your hands.

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Contamination of the outside of the bag is avoided to prevent the spread of microorganisms to the nurse and subsequently to others. Reduces transmission of microorganisms. Sterile dressings remain sterile while on or within sterile surface. Preparation of supplies prevents break in technique during dressing change. This creates a sterile working area thus keeping supplies sterile. Forceps or gloves are used to prevent contamination of the wound by the nurses hands and contamination of the nurses hands by wound drainage.

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10. Open the sterile dressing set by using the technique described for opening sterile packages. 11. Place the sterile drape beside the wound and on sterile gloves ( optional).

12. Remove

the under dressings with tissue forceps or sterile gloves , taking care not to dislodge any drains If the gauze sticks to the drain , use two pairs of forceps, one to remove the gauze and one to hold the drain , or secure the drain with one hand. the location, type ( color, consistency), and odor of wound drainage, and the number of gauzes saturated or the diameter of drainage collected on the dressings. the soiled dressings in the bag. To avoid contaminating the forceps tips on the edge of the paper bag , hold the dressings 10-15 cm ( 4-6in) above the bag , and drop the dressings into it. After the dressings are removed, discard the forceps or set them aside from the sterile field. the wound, using the second pair of artery or forceps and gauze swabs moistened with antiseptic solution. Keep the forceps tips lower than the handles at all the times. Use a separate swab for each stroke, cleaning from the top of the incision downward. Discard each swab after use. a. Clean with strokes from the top to the bottom, starting at the center and continuing to the outside. Or clean with strokes outward from the incision on one side and then outward on the other side. b. If drain is present, clean it after the incision. c. For irregular wounds, such as decubitus ulcer, clean from the center of the wound outward using circular strokes. process until all

13. Assess

Provides estimate of drainage assessment of wounds condition.

amount

and

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15. Discard

These forceps are now contaminated by the wound drainage.

16. Clean

The wound is cleaned form the least to the most contaminated area. Forceps tips are always held lower than the handle to prevent their contamination by fluid travelling up to the handle and back to the tips.

17. Repeat the cleaning drainage is removed.

Cleanses wound of drainage and promotes healing. Reduces excess moisture , which could eventually

18. Dry the wound with dry gauze swabs, using